title: The "lost anvil": an original technique for laparoscopic colorectal anastomosis.
abstract: OBJECTIVE
  During laparoscopic colorectal anastomosis, the rectal introduction of the circular stapler is achieved without hand assistance, increasing the risk of rectal injury. Therefore, we describe a technical adjustment facilitating rectal advancement of the stapler.
  
  
  METHODS
  Two hundred consecutive patients with benign condition underwent laparoscopic sigmoidectomy. Before any stapling, the complete circular stapler is introduced into the anus. The anvil is released in the lumen of the colon to be resected. After cross-stapling the rectum, the anvil is retrieved in the resected specimen before the final steps of the anastomosis. Feasibility, safety, and long-term results were evaluated.
  
  
  RESULTS
  In 194 patients, the anastomosis was successfully performed at upper rectal level. Only, 1 rectal wall injury was observed. At a median follow-up of 44 months, 3 patients presented anastomotic stenosis and 2 small-bowel obstructions.
  
  
  CONCLUSIONS
  "Lost anvil" technique allows easy and safe circular stapler rectal advancement for laparoscopic colorectal anastomosis in benign diseases.
authors.affiliation: *Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium †Policlinico di "Tor Vergata", Dipartimento di Chirurgia, Università di Roma "Tor Vergata", Rome, Italy.
authors.forename: Alex
authors.initials: A
authors.lastname: Kartheuser
authors.forename: Luca
authors.initials: L
authors.lastname: Pellegrino
authors.forename: Christophe
authors.initials: C
authors.lastname: Remue
authors.forename: Daniel
authors.initials: D
authors.lastname: Léonard
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dewaele
authors.forename: Nora A
authors.initials: NA
authors.lastname: Orabi
authors.forename: Hugh
authors.initials: H
authors.lastname: Paterson
authors.forename: Michel
authors.initials: M
authors.lastname: Mourad
authors.forename: Francesco
authors.initials: F
authors.lastname: Rulli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012810:Sigmoid Diseases / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult